Factors determining outcomes in grown up patients operated for congenital heart diseases

Sachin Talwar, Manikala V Kumar, Vishnubhatla Sreenivas, Shiv K Choudhary, Manoj Sahu, Balram Airan, Sachin Talwar, Manikala V Kumar, Vishnubhatla Sreenivas, Shiv K Choudhary, Manoj Sahu, Balram Airan

Abstract

Background: The number of grown ups with congenital heart diseases (GUCHs) is steadily increasing.

Aims: To analyze factors predicting early cardiac morbidity following cardiac surgery in GUCH at a tertiary care center.

Setting and design: Retrospective study at a multispeciality tertiary referral center.

Methods: Between January 2004 and December 2014, 1432 patients ≥13 years of age (acyanotic defects: 843, cyanotic defects: 589) underwent surgery for congenital heart defects. Factors associated with early cardiac morbidity were analyzed.

Statistical analysis: Univariable and multivariable analysis of all factors affecting outcomes.

Results: On multivariate analysis, previous sternotomy, aortic cross-clamp time >45 min, cyanosis, and emergency procedure were independent predictors of early morbidity with respective odds ratios (ORs) of 12.4, 3.6, 2.6, and 8.1. For more precise estimation, a risk score was generated. Taking the log odds with each of these four as respective weights, a score was generated. The variables were previous sternotomy (2.5), aortic cross-clamp >45 min (1.3), emergency procedure (2.1), and cyanosis (0.9), if the respective condition is present, zero otherwise. The score ranged from 0 to 4.5. The average value of the score based on the four variables was significantly higher in cases with morbidity (1.85 ± 1.17) vs. (0.75 ± 0.88), P < 0.001. Distribution of scores was significantly different between patients with and without morbidity. Sixty-seven percent patients without any morbidity had score <1 compared to 24.6% with morbidity. Only 0.9% patients without morbidity had score of ≥3 compared to 16.4% patients with morbidity. Compared with patients having score <1, patients with scores 1-2 had OR of 3.4, 2-3 had OR of 6.0, and >3 had OR of 48.7.

Conclusion: GUCH can be safely operated when adequate caution is taken in the presence of independent predictors such as previous sternotomy, aortic clamp time >45 min, cyanosis, and emergency procedure.

Keywords: Congenital heart disease in adults; delayed diagnosis; grown up congenital heart disease; reoperations.

Figures

Figure 1
Figure 1
Box plot showing pattern of scores between patients without and with morbidity. The median value of the score among the group with no morbidity is close to zero, compared with 1.4 in the group with morbidity. The 75th percentile (which is the top of the box) among the group with no morbidity is lower than the 25th percentile (which is the bottom of the box) among the group with morbidity

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Source: PubMed

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